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A 12-year-old girl presented with another episode of pyelonephritis. Her history was remarkable for multiple prior episodes of pyelonephritis over several months. Each episode was accompanied by flank pain and fever. Urine culture showed Escherichia coli on all occasions. Treatment for the first episodes was with oral cephalosporins for 10 days. Renal ultrasound did not show any abnormality of the urinary tract and the performed uroflow was normal. Underlying risk factors for recurrence of pyelonephritis such as bowel–bladder dysfunction and constipation were ruled out. A sufficient oral fluid intake as well as complete bladder voiding were discussed with the patient and her parents and were reported to be adequate.
During the current episode, an MRI was performed, suggesting a diagnosis of an acute focal bacterial nephritis (AFBN). A 2-week course of intravenous ceftriaxone was given followed by oral prophylactic treatment. Nonetheless, clinical relapse and new renal lesions on the follow-up MRI 6 weeks later were seen and prompted the team to treat her condition with a prolonged course of intravenous ceftriaxone over 4 weeks.
You wonder if an earlier prolonged antibiotic therapy for AFBN could have reduced the risk of recurrences.
Structured clinical question
In children with evidence of AFBN (population), is short duration of initial antimicrobial therapy (intervention) associated with the risk of recurrence (outcome)?
Primary search was conducted in EMBASE and MEDLINE via Ovid, PubMed and Google Scholar without time and language restriction (table 1). Search terms included acute focal bacterial nephritis, acute lobar nephronia, children, pediatric, relapse, recurrence. One hundred fifty-five unique potential articles were screened, with three …
NR and AG contributed equally.
Contributors NV formed the clinical question and reviewed the literature. NV wrote the manuscript. AG and NR critically reviewed the study proposal and contributed to the manuscript. HS, KE, NR and AG proofread the drafts and added further input. All authors (NV, HS, KE, NR and AG) proofread and approved the final version.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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